My Wife's Walk Through the Valley of Tonsil Cancer

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Staging the tumor

As I do further research on this thing, it just seems like the thing we need to be most worried about is not the size of the tumor, not so much on whether or not it has spread into adjacent structures, but whether or not any lymph nodes are involved.

Here’s how these things are staged.

A tumor 2cm or smaller is a T1. Bigger than 2cm but smaller than 4cm, T2. Bigger than 4cm, T3. Tumor that invades nearby structures, like base of tongue, mandible, hard palate, etc., T4.

Gail’s tumor, visibly, is hovering around 2cm. That would make hers a T1 or T2. The PET/CT scan will show for sure just how large it actually is.

If no lymph nodes are affected, N0. One lymph node on the same side as the tumor, 3cm or smaller? N1. Cancer found in two or more nodes, none larger than 6cm, N2. Any lymph node with cancer, larger than 6cm, N3.

The first CT in January didn’t show any nodes that looked suspicious. But that’s why they do PET scans. The nurse practitioner at the radiation oncologist visit yesterday said she could feel a couple nodes that seemed small, but a bit harder (more firm) than they should be. If the PET scan or dissection shows cancer in one node? N1. More than 1? N2.

If cancer has not been shown to have spread to a distant site, like bone, lung, liver? M0. Any spread to a distant site? M1.

We have no way of knowing if this has happened to Gail until we see the PET/CT Scan results. This, however, seems unlikely given how small the primary tumor seems to be.

So, they take these classifications and decide what “stage” your cancer is.

For instance… if Gail’s total tumor is 2cm or smaller, no lymph node involvement, no spread to distant organs — T1, N0, M0 means Stage I cancer.

If her tumor is between 2 and 4cm, but still no lymph nodes or spread? T2, N0, M0 means Stage II cancer.

If the tumor is larger than 4cm, but still no lymph node or spread? T3, N0, M0 means Stage III cancer.

Now…

No matter what size the tumor is, if it involves 1 lymph node on the same side of her neck but no spread to distant organs? T1-2 or -3, N1, M0 means Stage III cancer.

If more than one lymph node is involved, that automatically kicks it up to Stage IV. No matter the size of the tumor.

If the tumor has spread to a distant organ, no matter what size it is or how many lymph nodes? Stage IV.

OK. So the PET/CT scan will tell us the exact size of the tumor and whether or not lymph nodes were involved or if the cancer has spread to any distant organs.

One more thing to take into account. If the tumor has any DNA from a specific strain of the human papillomavirus, it won’t affect the staging whatsoever. But it will affect the survival rate. To put this as simply as I can, tonsil cancers caused by HPV are just “easier to kill” than cancers caused by tobacco or alcohol or other agents.

Overall 5-year survival rate by stage, and keep in mind these are averages — meaning half live longer, half live shorter.

Stage I — 80-90% Stage II — 70-80% Stage III — 50% Stage IV — 30%

All this means is if you take 100 people with tonsil cancer in each of these stages, that’s how many of them will likely still be alive after five years.

So, this is the info we’re waiting for, and we should have a complete report — as well as what happens next, and when — by Monday afternoon.